August 9, 2022  — With so many pregnant and lactating women exposed to COVID-19, information about the best way to stay safe and protect both mothers and babies is needed.  Drs. Stella Marie L. Jose, Chair, PGH Breastfeeding Committee and PGH Deputy Director for Health Operations, and Aurora Gloria I. Libadia, PGH Human Milk Bank Head, PGH Breastfeeding Committee Co-Chair,  and PGH Dept. of Pediatrics Clinical Associate Professor, spoke during the Stop COVID Webinar # 101 entitled “Ang Pagpapasuso sa Panahon ng Pandemya” that discussed the importance of breastfeeding during the pandemic and the ways to support and sustain breastfeeding.

Vaccination is key

“Vaccination is the key point to prevent maternal death,” explained Dr. Jose. She noted that zero maternal deaths due to COVID-19 were observed in the fully vaccinated and that majority of deaths were from the unvaccinated. Stating that COVID-19 vaccination is recommended for pregnant women, she said there is no evidence of maternal adverse effects and no reports of congenital anomalies associated with vaccination. The Department of Health advises getting the vaccine after the first trimester of pregnancy. After maternal vaccination, the IgG antibodies from the mother are passed on to the newborn across the placenta while the IgA antibodies are passed on to the newborn through the breast milk.

Dr. Jose continued that according to the World Health Organization (WHO), data shows absence of vertical transmission of COVID-19 through breastfeeding. It is encouraged that breastfeeding mothers with COVID-19 strictly follow the healthcare protocols such as the use of a face mask and hand washing to avoid transmission to the baby.

She added that the WHO recommends that the mother and infant be enabled to remain together immediately after birth to establish breastfeeding, whether they or their infants have been suspected or confirmed with COVID-19. This is called the unang yakap, or “first embrace”, and is achieved through the following steps: immediate thorough drying of the baby; early skin-to-skin contact within one hour from birth; properly timed cord clamping; and the non-separation of the newborn from the mother for early breastfeeding. In Kangaroo Mother Care, the baby is placed on the mother’s chest. This is done for low-birth-weight infants and for premature babies.

Benefits

“Breastfeeding provides the most secure food supply, the cleanest and safest form of infant nutrition.  It should be initiated within 60 minutes of life. If the initiation of breastfeeding is done after the first 24 hours of life, the risk of infection-related death will be doubled, and if performed when the mother is ready for discharge, the risk of infection-related death increases four-fold,” Dr. Jose stated.

Other benefits of breastfeeding include:  full of antibodies; prevents all forms of malnutrition; increases intelligence scores; prevents non-communicable diseases and severe uterine bleeding; prevents breast cancer and ovarian cancer; prevents postpartum depression; and is also a form of contraceptive. However, even with the benefits,  global breastfeeding rate has increased very little in the past two decades while sales of formula milk have doubled. In the Philippines, the exclusive breastfeeding rate remains slow at 34% and the early initiation of breastfeeding is only 57%. The World Health Assembly has set a target to increase exclusive breastfeeding to at least 50% by 2025.

Dr. Libadia discussed the milk chain path towards exclusive breastfeeding. This includes antenatal education, skin-to-skin contact at birth, initiation of breastfeeding within the first hour of life, placing mother and baby together, showing how to breastfeed, not giving supplements, breastfeeding on demand, not limiting the duration of feeding, emptying of one breast before offering the second breast, and expressing breast milk if mother and baby are separated.

She added that mothers should be sensitive to the infant’s feeding cues that include stirring, turning of the head, and opening of the mouth. Mid cues involve the movement of arms and legs and bringing the hand to the mouth. When the mother recognizes these cues, she should bring the baby to the breast; and not wait for the late cues which include crying which is a late sign of hunger. .

Dr. Libadia explained the optimal breastfeeding position for successful breastfeeding which is chest to chest or tummy to tummy. The baby’s body needs to be in line with the ear, shoulder, and hip in a straight line, close to the mother’s body, supported at the head, shoulders, and if newborn, the whole body.

Storage

She advised that mothers who are already working need to know how to collect and store their breast milk. At room temperature, breast milk lasts four to eight hours; inside the refrigerator at two to four degrees centigrade, it lasts one to eight days; if it can be placed in the freezer or in the compartment of a refrigerator, for two weeks; if using a two-door refrigerator, inside the freezer, three months; if using a deep freezer, six to 12 months; and if it’s already thawed in a refrigerator, it lasts for 24 hours. Slow thawing is accomplished by transferring the milk from the freezer to the refrigerator one day before use; quick thawing is accomplished by placing the milk in a large container of warm water or tap water.

Dr. Libadia pointed out that mothers should empty their breasts every two to three hours to sustain lactation and cup feeding with expressed breastmilk to prevent nipple confusion. She discussed that RA 100028 protects breastfeeding employees with the provision of a lactation period for breastfeeding employees in addition to mealtimes for a total of 40 minutes for an 8-hour work period.

She discussed that August every year is Breastfeeding Awareness Month when health institutions are encouraged to put up human milk banks to sustain milk production,. In 2009, the PGH Human Milk Bank was launched, and since then, has been  screening, collecting, processing, storing, and distributing pasteurized donor milk to meet the needs of pre-term and sick babies. Today, there are 27 human milk banks in the country.

A healthy breast milk donor willing to undergo  screening and submit to physical examination, serological testing (HIV, hepatitis, and congenital syphilis) can donate breast milk. To donate, contact 0920-6655490.

Charmaine Lingdas